Healthcare Provider Details

I. General information

NPI: 1861876625
Provider Name (Legal Business Name): OMAR AYYASH M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/11/2015
Last Update Date: 07/01/2026
Certification Date: 07/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1725 COOK AVE
ORLANDO FL
32806-2911
US

IV. Provider business mailing address

1725 COOK AVE
ORLANDO FL
32806-2911
US

V. Phone/Fax

Practice location:
  • Phone: 321-843-9017
  • Fax: 321-843-9019
Mailing address:
  • Phone: 321-843-9017
  • Fax: 321-843-9019

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2088P0231X
TaxonomyPediatric Urology Physician
License NumberME181403
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code208800000X
TaxonomyUrology Physician
License NumberMT209211
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: